Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 721 | WI |
NPI | 1386668143 |
---|---|
Provider Name | Dr. Thomas Evan Sinnett |
First Address | Racine, WI 53403-4433 |
Second Address | Milwaukee, WI 53295-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U60979 | (02) | WI |